scholarly journals Paramedic Recognition of Sepsis in the Prehospital Setting: A Prospective Observational Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Robert S. Green ◽  
Andrew H. Travers ◽  
Edward Cain ◽  
Samuel G. Campbell ◽  
Jan L. Jensen ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Screening Tool ◽  
Tertiary Hospital ◽  
Emergency Physicians ◽  
Likelihood Ratios ◽  
True Negative ◽  
Predictive Values ◽  
Study Team ◽  
Sepsis Screening

Background. Patients with sepsis benefit from early diagnosis and treatment. Accurate paramedic recognition of sepsis is important to initiate care promptly for patients who arrive by Emergency Medical Services.Methods. Prospective observational study of adult patients (age ≥ 16 years) transported by paramedics to the emergency department (ED) of a Canadian tertiary hospital. Paramedic identification of sepsis was assessed using a novel prehospital sepsis screening tool developed by the study team and compared to blind, independent documentation of ED diagnoses by attending emergency physicians (EPs). Specificity, sensitivity, accuracy, positive and negative predictive value, and likelihood ratios were calculated with 95% confidence intervals.Results. Overall, 629 patients were included in the analysis. Sepsis was identified by paramedics in 170 (27.0%) patients and by EPs in 71 (11.3%) patients. Sensitivity of paramedic sepsis identification compared to EP diagnosis was 73.2% (95% CI 61.4–83.0), while specificity was 78.8% (95% CI 75.2–82.2). The accuracy of paramedic identification of sepsis was 78.2% (492/629, 52 true positive, 440 true negative). Positive and negative predictive values were 30.6% (95% CI 23.8–38.1) and 95.9% (95% CI 93.6–97.5), respectively.Conclusion. Using a novel prehospital sepsis screening tool, paramedic recognition of sepsis had greater specificity than sensitivity with reasonable accuracy.

Evaluation of a novel approach to recognising community-acquired paediatric sepsis at ED triage by combining an electronic screening algorithm with clinician assessment

2020 ◽  
pp. emermed-2019-208746
Author(s):  
Sylvester Gomes ◽  
Darryl Wood ◽  
Salma Ayis ◽  
Nikolaos Haliasos ◽  
Damian Roland
Keyword(s):  
Clinical Assessment ◽  
Screening Tool ◽  
Final Diagnosis ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Electronic Screening ◽  
Novel Approach ◽  
Minor Injuries ◽  
Sepsis Screening ◽  
Clinician Assessment

ObjectiveWe report the utilisation and impact of a novel triage-based electronic screening tool (eST) combined with clinical assessment to recognise sepsis in paediatric ED.MethodsAn electronic sepsis screening tool was implemented in the paediatric EDs of two large UK secondary care hospitals between June 2018 and January 2019. Patients eligible for screening were children < 16 years of ages excluding those with minor injuries or who were brought directly to resuscitation. Subsequently, a retrospective evaluation was performed to determine the performance of the tool alone and in combination with clinical assessment after triage, to identify septic patients, using sensitivity, specificity, positive, negative predictive values (PPV and NPV) and likelihood ratios.Results19 912 children were triaged during the study period, of whom 90 (0.45%) were classified as having sepsis. 99% of all eligible patients were screened. The eST alerted for 2651 (13.3%) patients. After immediate physician assessment, 151 were treated for sepsis in the ED, of whom 70 had a final diagnosis of sepsis. Eight patients who were not thought to be septic returned with sepsis within 24 hours. The eST showed a sensitivity of 86.7% (95% CI 77.5% to 92.6%), specificity 87.0% (95% CI 86.5% to 87.5%), PPV 2.94% (95% CI 2.35% to 3.68%), NPV 99.9% (95% CI 99.8% to 99.9%) which improved with combined clinical assessment to a sensitivity of 90.0% (95% CI 81.4% to 95.0%), specificity 99.4 (95% CI 99.3% to 99.5%), PPV 42.0 (95% CI 35.0% to 49.3%) and NPV 99.9% (95% CI 99.9% to 99.9%).ConclusionUtilisation of a novel triage-based eST allowed sepsis screening in over 99% of eligible patients. The screening tool showed good accuracy to recognise sepsis at triage in the ED, which was augmented further by combining it with clinician assessment. The screening tool requires further refinement through multicentre evaluation to avoid missing sepsis cases.

Clinical spectrum, aetiology and predictors of acute febrile encephalopathy at a tertiary hospital in south India – A prospective observational study

2020 ◽  
pp. 004947552096791
Author(s):  
Manoj Job ◽  
Alice J Mathuram ◽  
Vijay P Turaka ◽  
Ronald AB Carey ◽  
Ramya Iyyadurai ◽  
...  
Keyword(s):  
Observational Study ◽  
Functional Outcome ◽  
Prospective Observational Study ◽  
South India ◽  
Altered Mental Status ◽  
Tertiary Hospital ◽  
Emergency Physicians ◽  
One Year ◽  
The Tropics ◽  
Infectious Aetiology

Acute febrile encephalopathy is a common syndrome in the tropics with high mortality encountered by emergency physicians. In order to study the aetiology of acute febrile encephalopathy and its mortality and functional outcome over one year, data on all patients >18 years of age with short duration of fever (<14 days) and altered mental status were collected and followed up until one month after discharge. Non-infectious aetiology, found in 29%, portends a poor outcome.

scholarly journals Prevalence, associated factors and treatment of post spinal shivering in a Sub-Saharan tertiary hospital: a prospective observational study

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Tonny Stone Luggya ◽  
Richard Nicholas Kabuye ◽  
Cephas Mijumbi ◽  
Joseph Bahe Tindimwebwa ◽  
Andrew Kintu
Keyword(s):  
Observational Study ◽  
Associated Factors ◽  
Prospective Observational Study ◽  
Tertiary Hospital ◽  
Sub Saharan

scholarly journals Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e048795
Author(s):  
Bram Kok ◽  
Frederik Schuit ◽  
Arthur Lieveld ◽  
Kaoutar Azijli ◽  
Prabath WB Nanayakkara ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Diagnostic Accuracy ◽  
Prospective Observational Study ◽  
Lung Ultrasound ◽  
Final Diagnosis ◽  
Likelihood Ratios ◽  
Reverse Transcription Pcr ◽  
Registration Number ◽  
Sensitivity Specificity

BackgroundBedside lung ultrasound (LUS) is an affordable diagnostic tool that could contribute to identifying COVID-19 pneumonia. Different LUS protocols are currently used at the emergency department (ED) and there is a need to know their diagnostic accuracy.DesignA multicentre, prospective, observational study, to compare the diagnostic accuracy of three commonly used LUS protocols in identifying COVID-19 pneumonia at the ED.Setting/patientsAdult patients with suspected COVID-19 at the ED, in whom we prospectively performed 12-zone LUS and SARS-CoV-2 reverse transcription PCR.MeasurementsWe assessed diagnostic accuracy for three different ultrasound protocols using both PCR and final diagnosis as a reference standard.ResultsBetween 19 March 2020 and 4 May 2020, 202 patients were included. Sensitivity, specificity and negative predictive value compared with PCR for 12-zone LUS were 91.4% (95% CI 84.4 to 96.0), 83.5% (95% CI 74.6 to 90.3) and 90.0% (95% CI 82.7 to 94.4). For 8-zone and 6-zone protocols, these results were 79.7 (95% CI 69.9 to 87.6), 69.0% (95% CI 59.6 to 77.4) and 81.3% (95% CI 73.8 to 87.0) versus 89.9% (95% CI 81.7 to 95.3), 57.5% (95% CI 47.9 to 66.8) and 87.8% (95% CI 79.2 to 93.2). Negative likelihood ratios for 12, 8 and 6 zones were 0.1, 0.3 and 0.2, respectively. Compared with the final diagnosis specificity increased to 83.5% (95% CI 74.6 to 90.3), 78.4% (95% CI 68.8 to 86.1) and 65.0% (95% CI 54.6 to 74.4), respectively, while the negative likelihood ratios were 0.1, 0.2 and 0.16.ConclusionIdentifying COVID-19 pneumonia at the ED can be aided by bedside LUS. The more efficient 6-zone protocol is an excellent screening tool, while the 12-zone protocol is more specific and gives a general impression on lung involvement.Trial registration numberNL8497.

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